ORDER OF THE MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION

of January 15, 2007 No. 31

About procedure and conditions of additional payment to the primary health care given by out-patient and polyclinic organizations to the working citizens within the territorial program of compulsory medical insurance

In pursuance of article 20 of the Federal Law of December 19, 2006 N234-FZ "About the Budget of Social Insurance Fund of the Russian Federation for 2007" ("The Russian newspaper" of December 29, 2006 N 295) and orders of the Government of the Russian Federation of December 30, 2006 N864 "About Procedure for Financing in 2007 of Expenses on Additional Payment to the Primary Health Care Given by Out-patient and Polyclinic Organizations to the Working Citizens within the Territorial Program of Compulsory Medical Insurance at the expense of the Funds Transferred to Social Insurance Fund of the Russian Federation from the Budget of Federal Compulsory Health Insurance Fund" ("The Russian newspaper" of January 11, 2007 N 2) I order:

1. Approve the enclosed Procedure and conditions of additional payment to the primary health care given by out-patient and polyclinic organizations to the working citizens within the territorial program of compulsory medical insurance.

2. To impose control of execution of this order on the deputy minister of health care and social development of the Russian Federation V. I. Starodubov.

Approved by the order of the Ministry of Health and Social Development of the Russian Federation of January 15, 2007 No. 31

Procedure and conditions of additional payment to the primary health care given by out-patient and polyclinic organizations to the working citizens within the territorial program of compulsory medical insurance

1. This Procedure regulates conditions and procedure in 2007 Social Insurance Fund of the Russian Federation of functions on additional payment to the primary health care given by out-patient and polyclinic organizations to the working citizens within the territorial program of compulsory medical insurance at the expense of the funds transferred to Social Insurance Fund of the Russian Federation from the budget of Federal Compulsory Health Insurance Fund (further - additional payment of primary health care).

2. The Federal Compulsory Health Insurance Fund from the account opened in accordance with the established procedure in division of settlement network of the Central bank of the Russian Federation on the balance sheet account on accounting of means of Federal Compulsory Health Insurance Fund transfers funds for additional payment of primary health care into the account of Social Insurance Fund of the Russian Federation opened in accordance with the established procedure in division of settlement network of the Central bank of the Russian Federation on the balance sheet account on accounting of fund of social insurance of the Russian Federation.

3. Additional payment of primary health care is made by regional departments of Social Insurance Fund of the Russian Federation (further - regional department) according to agreements which standard form is approved by the order of the Government of the Russian Federation of December 30, 2006 N 864, concluded with territorial funds of compulsory medical insurance (further - territorial fund) and the out-patient and polyclinic organizations having the license for medical activities and providing medical care within territorial programs of compulsory medical insurance (further - out-patient and polyclinic organization).

4. The services in primary health care rendered to the working citizens insured for case of temporary disability in system of compulsory medical insurance and mandatory pension insurance in the period of their temporary disability confirmed with the disability leaves issued to them are subject to additional payment (further - the working citizens).

5. The services in primary health care rendered by out-patient and polyclinic organizations within calendar year during validity on provision of medical services in compulsory medical insurance within the funds transferred to regional department on payment of the corresponding services are subject to additional payment.

6. The services in primary health care rendered to women during pregnancy and childbirth, paid based on birth certificates are not subject to additional payment.

7. Additional payment of primary health care is made by regional departments in the amount of 25 percent of the amount of the accounts on payment of the primary health care given to the working citizens within the territorial program of compulsory medical insurance, paid by medical insurance companies (in case of their absence - territorial funds).

At the same time the services in primary health care rendered by out-patient and polyclinic organizations according to orders of the Ministry of Health and Social Development of the Russian Federation of July 29, 2005 to N487 "About Approval of Procedure for the Organization of Rendering Primary Health Care" are subject to payment (it is registered in the Ministry of Justice of the Russian Federation on August 30, 2005 N 6954) and of October 13, 2005 N633 "About the Organization of Medical Care" (according to the conclusion of the Ministry of Justice of the Russian Federation does not need state registration, the letter of the Ministry of Justice of the Russian Federation of October 27, 2005 of N01/8234-VYa), except for the medical care provided in day hospitals of out-patient and polyclinic organizations.

8. Additional payment of primary health care is performed based on the accounts on payment of 25 percent of the amount of the accounts on payment of the primary health care given to the working citizens within the territorial program of compulsory medical insurance paid by medical insurance companies (in case of their absence - territorial funds), which passed in accordance with the established procedure the medico-economic examination, drawn up on each out-patient polyclinic organization, signed by the authorized head the official of out-patient and polyclinic organization, registers of these accounts with mark that the provided accounts are checked by territorial fund, and also the information about the working citizens which are given primary health care within the territorial program of compulsory medical insurance, constituted according to the procedure and in form the approved Federal Compulsory Health Insurance Fund together with Social Insurance Fund of the Russian Federation.

In case of non-compliance with the requirements established by the first paragraph of this Item primary health care is not subject to additional payment.

9. By provision by territorial fund in regional department of data on change of the amounts of accounts on payment of 25 percent of the amount of accounts for the primary health care given to the working citizens within the territorial program of compulsory medical insurance the reasons of such changes and the basis which served as the reason of adjustments of the amounts of the accounts accepted for payment (the copy of reconciliation statements of calculations) are specified.

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